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Antiepileptic Drugs: Modulators of Neurotransmitter Release Mediated by SV2A Protein01:20

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Antiepileptic drugs, such as levetiracetam (Keppra) and brivaracetam (Briviact), have emerged as crucial tools in managing epilepsy. These medications exert their therapeutic effects by targeting the synaptic vesicle protein SV2A, a transmembrane glycoprotein primarily found in the brain.
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Related Experiment Video

Updated: Oct 3, 2025

A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
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Dual-Device Neuromodulation in Epilepsy.

Brin Freund1, Sanjeet S Grewal2, Erik H Middlebrooks3

  • 1Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA.

World Neurosurgery
|February 21, 2022
PubMed
Summary
This summary is machine-generated.

Dual neurostimulation using vagus nerve stimulation (VNS) with deep brain stimulation (DBS) or responsive neurostimulation (RNS) is safe for epilepsy. Device choice depends on seizure localization and prior VNS response.

Keywords:
Deep brain stimulatorEpilepsyNeuromodulationResponsive neurostimulatorSafetySeizures

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Area of Science:

  • Neurology
  • Neurosurgery
  • Biomedical Engineering

Background:

  • Current neuromodulation methods reduce seizures in drug-resistant epilepsy when surgery isn't feasible.
  • Dual neurostimulation is understudied despite polytherapy use in epilepsy management.

Purpose of the Study:

  • To identify trends in dual neurostimulation for epilepsy.
  • To understand factors influencing the choice between deep brain stimulation (DBS) and responsive neurostimulation (RNS) when combined with vagus nerve stimulation (VNS).

Main Methods:

  • Retrospective review of patients undergoing VNS, DBS, or RNS at Mayo Clinic Florida (1998-2021).
  • Dual therapy defined as active VNS with DBS or RNS.
  • Analysis of patient characteristics and seizure types.

Main Results:

  • Active dual stimulation occurred in 8/8 patients receiving DBS and 3/28 receiving RNS.
  • VNS-DBS patients had prior VNS response and were unresponsive to more antiseizure medications.
  • VNS-RNS patients more frequently had focal seizures with electroclinical localization and underwent invasive electroencephalography.

Conclusions:

  • Seizure localization guides RNS vs. DBS selection.
  • Prior VNS response is more common in DBS patients.
  • Dual neuromodulation therapy is safe, warranting further multicenter research.